CONFIDENTIAL SPDF-2006-1 [A]

STRATEGIC PLANS DIVISION Latest Passport Size

INITIAL SECURITY CLEARANCE Photograph
PROFORMA (Coloured)

(Name of Commission/Organization)
2” x 1.75”
Appointment Applied for & SPS Internee

Instructions: Paste inside this box

1. No column will be left blank (mark ‘NA’ or ‘Nil’ whatever may apply). DO NOT staple
2. Attach extra sheets where required.
3. Any change to the information given below will be reported by the individual.
4. DONOT forget to make a photocopy of filled form for you personal record.
5. All Dates should be entered in the format “DD-MM-YYYY”

PERSONAL INFORMATION
1. Identification
a. NADRA NIC: 4 2 2 0 1 - 3 2 1 8 9 4 5 - 9

b. Full Name (in block letters): ALI HAIDER

c. Father’s Name: Shabbir Hussain

d. Previous Name (if any) – also reason for change:

e. Alias / Nick Name (if any):

f. Caste (Awan / Rajput etc): Changazi____ m. Blood Group: O- neg

g. Date of Birth: 0 5 - 0 7 - 1 9 9 8 n. Place of Birth: Karachi

h. Religion: Islam o. Sect (Sunni, Shia etc):

j. Visible Marks of Identification: mole on head ____ p. Retd Armed Forces Pers

k. Religion By Birth (if different from Column h) (1) Rank

l. Domicile: Panoaqil Sukkur(R) (2) Svc No

2. Residential Address:

a. Permanent Address:

Rural Area Urban Area

Village/Post Office: Unchi bazar House / St No: _____

Street No: Sector/Mohallah/Block: _______

Tehsil/District: Pano-Aqil Police Station

Police Station: Unchi Bazar City:

Province: Sindh Province:

Tele No (s): Tele No (s):

b. Present Address: (if other than at ser 2 a)

House/St No: o-15/16 Sector/Mohallah/Block: Al-badar society

Police Station Al-Fallah City: Karachi Teh & Distt Malir

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Province Sindh Contact No (s) 03100095468

Notables of Area

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c. Addresses during last 5 years (if other ser 2 a & b)
S/No From To Address

a.

b.

c.

3. Educational Record:

Name & Complete Address of From To Year/ Roll No./ Standard Subjects
Institute Session Registration Attained
(University / College etc) No.
Name: Cadet Collage Larkana

2012- Matricul
Address: Larkana 2012 2014 42637 science
2014 ation

Name: Cadet collage Larkana

Pre-
Address: Larkana
2015- Intermed
2015 2016 90350 Engineer
2016 iate
ing

Name: M.U.E.T S.Z.A.B Campus khp

Address: Luqman phatak Driti fakirari road khairpur

presen 2016-
2016 KF16SW34 B.E S.W.E
t present

Name:

Address:

4. Foreign Languages:

S/No Languages Understand Read Write Speak Interpret

English A A A A
a. A

b.

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5. Political / Social Activities / Membership of Social Orgs / Clubs:

S/No Details

NA
a.

b.

6. Passport:

S/No Documents Type Number Issue Expiry Issuing

Description (Official / Private) Date Date Authority
official Cp697451 14/7/2013 13/4/2022 Pakistan
01 Passport Private

7. Visits Abroad

Country Name Departure Return Date Official / Private Purpose

Date
Japan (Tokyo)
20/6/2017 5/7/2017 official Exchange student

7.(a) Visits Abroad (In case of long study visits, provide complete Education Details
Registration No./Session/Name of Institute, Residential Address and Subjects of Study :

8. Dual Nationality (Details):

9. Record of Previous Service (Last 5 Years):

Depts / Firms Designation From To Reason for

( with Address) and Pay Leaving
Name:
NA NA NA

Address:
NA

Name:

Address:

Name:

Address:

Name:

Address:

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10. Family Details:

Note, - Full information in respect of Application’s Family including Spouse/Father/Mother/Children/Brothers/Sisters, Father-in Law/Mother-in Law/
Brothers and Sisters-in Law be furnished. Additional information in respect of Wife / Husband’s name, date and place of birth, date and place of
marriage, nationality, CNIC No and religion before marriage should also be furnished in remarks column (Attach Extra sheet if required)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
Full Name Sex Relation CNIC No. Religion Caste Occupation Age/ Wheth Address/ Tele Politi Remark
With / Date of er Nos cal s
Candidates Sect Birth Depen Affili
dent on ation
you if
Any
Shabbir M Father 42201-082763-7 Islam Changazi Civil 14/7/1970 NO Albadar no
Servant Society Malir
Hussain
BPS-16 Halt o-15/16
Changazi
house
Tahira Parveen F Mother 42501-2303649-4 Islam Changazi House no Albadar no
Wife Society Malir
Halt o-15/16
Changazi
house
Shahtaj F Sister 42201-8362554-6 Islam Changazi Student no Albadar no
Society Malir
Halt o-15/16
Changazi
house

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Bakhtawar F Sister 42201-7359940-2 Islam Changazi Student no Albadar No

Society Malir
Halt o-15/16
Changazi
house
Areesha F Sister 42201-7368395-2 Islam Changazi Student no Albadar no
Society Malir
Halt o-15/16
Changazi
house

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11. Court / Judicial Record / Publishments:

Have you ever been tried by any court? Yeas No (If your answer is “Yes” then provide following details)

Act under which tried & Case Status Court Type

Ser Offence / Change Country
Decision of the Court (Pending/Closed) (Criminal / Civil / Military)

Description Act under which tried Type

Decision of the court City / Distt

Date Decision of the court City / Distt

12. Details of Relatives in India/Bangladesh/Afghanistan:

Full Name Relationship Occupation Address

13. Details of Near Relatives in Foreign Countries (Less Mentioned in ser 12)

Full Name Relationship Occupation Address

Signature of Applicant

Date:-

Station:-

ATTESTATION
(By Head of Educational Institutions/Previous Employer/CO)

The above particulars are correct to the best of my knowledge and all columns have been filled to.

Signature.
Name. Dr. Nouman Qadeer
(in block capitals)

Designation.
Address.
Date.

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